The Client

Our client is a top 20, global pharmaceutical company with nearly $20 billion in revenue in 2018. The company focuses on Diabetes.

Client’s Need and Challenges

  • The client was looking for a unique and innovative approach to value-based care analytics, to help make decisions on which patient segments to go “at risk” with, how to position and structure the contract, and how to measure performance/outcomes.
  • The client needed additional data and analytic models to support value-based care scoring and score carding.

Our Approach and Methodology

To meet the client’s needs, EXL used its unique risk and impactability scoring algorithms. EXL identifies the key drivers that impact total cost of care (TCoC) and result in differently observed TCoC for each therapy. For example, how much of the lower TCoC for a SGLT-2 is attributed to a less sick starting population, lower age, differences in other pharmacotherapies, etc. Ideally, EXL likes to be able to actually isolate the impact of the pharmacy intervention separate from other major drivers.

EXL designed a TCoC patient waterfall that is optimal for the client’s GLP-1 products.

  • TCoC Model: EXL created a TCoC model, by product, for the diabetes drug class (SGLT-2, GLP-1, DPP-4, etc.) across the commercial and Medicare lines of business.
  • Prospective Risk Metric: EXL then created a Prospective Risk Metric based on the diabetes drug class and each product within the class.
  • Compliance/Adherence: EXL created a PDC 80 (proportion of days covered) metric by product and class to understand patient compliance of diabetes therapies.
  • Geographic Variation Analysis: EXL then provided a national TCoC metric and differentiate based on geographical distribution by region (6 regions were client defined).

For this extensive analysis, EXL used the following Dimensions and Measurements.


  • Type 2 Diabetes class (GLP-1, SGLT1, DPP-4, etc.): Products, Geographic Areas, Line of Therapy, Patient Persona segments, Line of Business (Commercial and Medicare), Prospective Risk segment (High, Medium, Low), Impactability Score (High, Medium, Low), Age groups, Gender, and Route of Administration (oral/injectable).


  • Total Medical Per Member Per Month Allowed amounts for Inpatient Acute (drilldown of cerebral, heart and peripheral vascular DRGs), Inpatient Surgical, Emergency Room, Outpatient Medical (drill down for dialysis and retinopathy), Outpatient Surgical, Evaluation and Maintenance, and Ancillary
  • Total Pharmacy Per-Member-Per-Month Allowed Amounts
  • Prospective Risk Score
  • Impactability Score
  • Proportion of Days Covered (PDC) Adherence
  • Percentage of Comorbid Conditions

Our Approach and Methodology

Analysis of Patient Treatment Journey for Type 2 Diabetes: EXL identified the line of therapy (LoT) for newly diagnosed patients.

  • Line of Therapy TCoC Analysis: For each LoT, EXL compared the TCoC for high- vs. low-risk patients and the TCoC for high- vs. low-dose products for existing and newly diagnosed patients. EXL then identified the patient treatment “waterfall” effect, including but not limited to drivers at class and product level that prohibit or drive adherence, drivers that drive higher cost of care, and drivers at a Patient Persona level that can be used to identify positive or non-positive outcomes.
  • Patient Personas: EXL created Patient Personas for commercial line for business for the Type 2 diabetes patient population, differentiating TCoC by persona type.

Anticipated Results & Utility

The client expects a Type 2 Diabetes Cost of Care and Patient Treatment Path analytics and insights (delivered in a dynamic Tableau platform) to support current and future valuebased contracting strategies and positioning.

Written by EXL Health Team

Contact US